Dealing with Pain in Childbirth

Childbirth is accompanied by pain; expectation of this pain can evoke fear and anxiety in you. This is normal. If you're concerned about pain and how you'll handle it, the best way to deal with it is to become informed about it.

Many women believe they'll feel guilty after their baby is born if they ask for pain relief during labor. Sometimes they believe the baby will be harmed by the medication. Some believe they'll deprive themselves of the complete birth experience. I tell my patients the main goal of any labor and delivery is a healthy baby and healthy mom. If a woman wants pain relief to help her, it doesn't mean she's failed in any way!

Analgesia and Anesthesia

These two methods of pain relief have effects that are quite different. Analgesia is pain relief without total loss of sensation. Anesthesia is pain relief with total loss of sensation.

Analgesia.
An analgesic is injected into a muscle or vein to decrease the pain of labor, but it allows you to remain conscious. It provides pain relief but can make you drowsy, restless and nauseous. You may experience difficulty concentrating. It may slow the baby's reflexes and breathing, so it is usually given during the early and middle parts of labor.

Anesthesia.
There are three types of anesthesia— general, local and regional anesthesia. With general anesthesia, you are completely unconscious, so it is used only for some Cesarean deliveries and emergency vaginal deliveries. Local anesthesia affects a small area and is particularly useful for an episiotomy repair. Regional anesthesia affects a larger body area than local anesthesia.

General anesthesia is not used as much today as in the past. The advantage of general anesthesia is that it can be administered quickly in an emergency. Disadvantages include causing the mother to vomit or to aspirate vomited food or stomach acid into her lungs. With general anesthesia, the baby may be "asleep" when delivered. By contrast, local anesthesia rarely affects the baby and usually has few lingering effects.

There are several types of local and regional anesthesia. The three most common types are pudendal block, spinal block and epidural block.

Pudendal block.
A pudendal block is medication injected into the vaginal area to relieve pain in the vagina, the perineum and the rectum. Side effects are rare. It is considered one of the safest forms of pain relief; however, it does not relieve uterine pain.

Spinal block.
With a spinal block, medication is injected into spinal fluid in the lower back, which numbs the lower part of the body. This type of block is administered only once during labor, so it is often used just before delivery. It works quickly and is an effective pain inhibitor. It is also used for a Cesarean delivery.

Epidural block.
In an epidural block, a tube is inserted into a space outside the mother's spinal column in the lower back. Medication is administered through the tube for pain relief. The tube remains in place until after delivery so additional medication can be administered when necessary, or it can be given continuously with a pump.

An epidural causes some loss of sensation in the lower part of the body. It helps relieve painful uterine contractions, pain in the vagina and rectum as the baby passes through the birth canal and the pain of an episiotomy. A woman can still feel pressure, so she can push adequately during vaginal delivery.

An epidural block is not effective in some women. Because an epidural may make it harder to push, vacuum extraction or forceps may be necessary during delivery.

Side effects of spinal block or epidural block. Either block can cause a woman's blood pressure to drop suddenly, which in turn can cause a decrease in the baby's heart rate. These blocks are not used if the woman is bleeding heavily or if the baby has an abnormal heartbeat. A woman may experience a severe headache if the covering of the spinal cord is punctured during needle insertion with either type of anesthesia. This happens rarely.

Walking spinal.
A walking spinal, also called intrathecal anesthesia, can be given to women who suffer extreme pain in the early stages of labor (dilated less than 5cm). A small amount of narcotic, such as Demerol, is injected through a thin needle into the spinal fluid, which eases the pain and causes few side effects.

Because the dose is small, neither the mother nor baby becomes overly drowsy. Sensory and motor functions remain intact, so the mother can still walk around with help or sit in a chair.

A walking epidural numbs you only in the pelvic area; it doesn't interfere with your ability to move your legs. Another advantage is that fewer women who have had a walking epidural have a "spinal headache" after the epidural wears off.

As with a regular epidural, you must have an I. V. in place during most of your labor. This is because the walking epidural, like a regular epidural, requires I. V. fluids to keep your blood pressure from falling.

At present, its use is limited, but the number of hospitals using walking epidurals is growing. Further testing is necessary before the procedure becomes widely available.